SSD Denials: What Are They Based On?

9 Common Reasons Why A Claim May Be Denied

Only one-third of initial Social Security disability claims are approved at the application level. Understanding the reasons why so many claims are denied can help increase the chances of a successful disability application.

Lack of Medical Evidence

An applicant may assert any number of medical impairments. A claim will not succeed, however, without objective medical evidence showing a clear diagnosis of the alleged impairments.

The medical evidence must demonstrate how these impairments would interfere with an applicant’s ability to work.

Lack of Severity

SSA must believe the condition is so severe as to last at least 12 months or result in death.

Surprisingly many cancer claims are denied due to lack of severity because the cancer is treatable within a 12 month period. The same considerations apply to stroke victims.

Duration Not Met

Claims may be denied because the impairments are not likely to cause disability for 12 months.

Claims based on bone fractures resulting from trauma or accidents are a common example.

Applicant’s Income Exceed Substantial Gainful Activity Allowance

Failure to Follow Treatment

If an applicant is unwilling to cooperate with prescribed medical treatment, the claim will be denied. This is referred to as medical noncompliance.

IMPORTANT – this is different from an applicant being unable to follow treatment due to lack of insurance, financial constraints, or religious beliefs.

Failure to Cooperate

If an applicant fails to provide requested information or fails to show up for scheduled medical exams, the claim will be denied.

Incarceration

Benefits will not be paid to those confined to a jail, prison, or state hospital – for either a misdemeanor or a felony – because food, shelter and medical needs are provided during incarceration.

Impairment Caused During a Crime

Impairments, or worsening of an existing impairment, that are incurred during the commission of a felony cannot be used as the basis for applying for disability benefits.

An injury suffered while an applicant is in prison cannot be used to obtain disability benefits.

Disability Caused by Drugs/Alcohol

Benefits will be denied if drug addiction and/or alcoholism is a contributing factor to his or her disability.

SSA considers whether the impairment would exist if applicant stopped using drugs or alcohol.

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